Alcoholism
that results in or physical problems.}} The disorder was previously divided into two types: * * . In a medical context, alcoholism is said to exist when two or more of the following conditions are present: *a person drinks large amounts of alcohol over a long time period, *has difficulty cutting down, *acquiring and drinking alcohol takes up a great deal of time, *alcohol is strongly desired, *usage results in not fulfilling responsibilities, *usage results in social problems, *usage results in health problems, *usage results in risky situations, * occurs when stopping, and has occurred with use. Risky situations include or having , among other things. Alcohol use can affect all parts of the body, but it particularly affects the brain, heart, liver, and . This can result in , , , an impaired immune response, liver and , among other diseases. Drinking during can cause damage to the baby resulting in s. Women are generally more sensitive than men to the harmful physical and mental effects of alcohol. Environmental factors and genetics are two components associated with alcoholism, with about half the risk attributed to each. Warning signs Psychiatric Long-term misuse of alcohol can cause a wide range of problems. Severe problems are common; approximately 10 percent of all dementia cases are related to alcohol consumption, making it the second leading cause of . Excessive alcohol use causes , and psychological health can be increasingly affected over time. are significantly impaired in people suffering from alcoholism due to the neurotoxic effects of alcohol on the brain, especially the area of the brain. The social skills that are impaired by include impairments in perceiving facial emotions, perception problems and deficits; the ability to understand humour is also impaired in alcohol abusers. Psychiatric disorders are common in alcoholics, with as many as 25 percent suffering severe psychiatric disturbances. The most prevalent psychiatric symptoms are and disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence. , , and may be caused by alcohol misuse, which can lead to a misdiagnosis such as . can develop or worsen as a direct result of long-term alcohol misuse. The co-occurrence of and alcoholism is well documented. Among those with occurrences, a distinction is commonly made between depressive episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that are primary and do not remit with abstinence ("independent" episodes). Additional use of other drugs may increase the risk of depression. Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a co-occurring psychiatric diagnosis such as , , , , (PTSD), or . Men with alcohol-use disorders more often have a co-occurring diagnosis of or , , , s or (ADHD). Women with alcoholism are more likely to experience physical or , abuse and than women in the general population, which can lead to higher instances of psychiatric disorders and greater dependence on alcohol. Social effects , }}, , and .}} Alcoholism is associated with , which can lead to financial problems. Drinking at inappropriate times and behavior caused by reduced judgment can lead to legal consequences, such as criminal charges for or public disorder, or civil penalties for ious behavior, and may lead to a criminal sentence. An alcoholic's behavior and mental impairment while drunk can profoundly affect those surrounding him and lead to isolation from family and friends. This isolation can lead to and , or contribute to . Alcoholism can also lead to , with subsequent lasting damage to the emotional development of the alcoholic's children. For this reason, children of alcoholic parents can develop a number of emotional problems. For example, they can become afraid of their parents, because of their unstable mood behaviors. In addition, they can develop considerable amount of shame over their inadequacy to liberate their parents from alcoholism. As a result of this failure, they develop wretched self-images, which can lead to depression. Alcohol withdrawal poster from the Union des Françaises contre l'Alcool (this translates as "Union of French Women Against Alcohol"). The poster states "Ah! Quand supprimera-t'on l'alcool?", which translates as "Ah! When will we nation abolish alcohol?"}} As with similar substances with a sedative-hypnotic mechanism, such as and , withdrawal from alcohol dependence can be fatal if it is not properly managed. Alcohol's primary effect is the increase in stimulation of the , promoting depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in and . When alcohol consumption is stopped too abruptly, the person's nervous system suffers from uncontrolled firing. This can result in symptoms that include , life-threatening s, , hallucinations, shakes and possible . Other neurotransmitter systems are also involved, especially , and . Severe acute withdrawal symptoms such as and seizures rarely occur after 1-week post cessation of alcohol. The acute withdrawal phase can be defined as lasting between one and three weeks. In the period of 3–6 weeks following cessation increased anxiety, depression, as well as sleep disturbance, is common; fatigue and tension can persist for up to 5 weeks as part of the ; about a quarter of alcoholics experience anxiety and depression for up to 2 years. These post-acute withdrawal symptoms have also been demonstrated in animal models of alcohol dependence and withdrawal. A also occurs in alcoholics whereby each subsequent withdrawal syndrome is more severe than the previous withdrawal episode; this is due to neuroadaptations which occur as a result of periods of abstinence followed by re-exposure to alcohol. Individuals who have had multiple withdrawal episodes are more likely to develop seizures and experience more severe anxiety during withdrawal from alcohol than alcohol-dependent individuals without a history of past alcohol withdrawal episodes. The kindling effect leads to persistent functional changes in brain neural circuits as well as to . Kindling also results in the intensification of psychological symptoms of alcohol withdrawal. There are decision tools and questionnaires which help guide physicians in evaluating alcohol withdrawal. For example, the CIWA-Ar objectifies alcohol withdrawal symptoms in order to guide therapy decisions which allows for an efficient interview while at the same time retaining clinical usefulness, validity, and reliability, ensuring proper care for withdrawal patients, who can be in danger of death. Causes 's , 1751}} A complex mixture of genetic and environmental factors influences the risk of the development of alcoholism. Genes that influence the metabolism of alcohol also influence the risk of alcoholism, as can a family history of alcoholism. One paper has found that alcohol use at an early age may influence the which increase the risk of alcohol dependence. Individuals who have a genetic disposition to alcoholism are also more likely to begin drinking at an earlier age than average. Also, a younger age of onset of drinking is associated with an increased risk of the development of alcoholism, and about 40 percent of alcoholics will drink excessively by their late adolescence. It is not entirely clear whether this association is causal, and some researchers have been known to disagree with this view. is also associated with a general increase in the risk of drug dependency. Lack of peer and family support is associated with an increased risk of alcoholism developing. Genetics and adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol abuse. degeneration due to the neurotoxic effects increases impulsive behaviour, which may contribute to the development, persistence and severity of alcohol use disorders. There is evidence that with abstinence, there is a reversal of at least some of the alcohol induced central nervous system damage. The use of cannabis was associated with later problems with alcohol use. Alcohol use was associated with an increased probability of later use of tobacco and illegal drugs such as cannabis. Gender difference Based on combined data from 's 2004–2005 National Surveys on Drug Use & Health, the rate of past-year alcohol dependence or abuse among persons aged 12 or older varied by level of alcohol use: 44.7% of past month heavy drinkers, 18.5% binge drinkers, 3.8% past month non-binge drinkers, and 1.3% of those who did not drink alcohol in the past month met the criteria for alcohol dependence or abuse in the past year. Males had higher rates than females for all measures of drinking in the past month: any alcohol use (57.5% vs. 45%), binge drinking (30.8% vs. 15.1%), and heavy alcohol use (10.5% vs. 3.3%), and males were twice as likely as females to have met the criteria for alcohol dependence or abuse in the past year (10.5% vs. 5.1%). Genetic variation There are differences between African, East Asian and European groups in how they metabolize alcohol. These genetic factors partially explain the differing rates of among racial groups. The allele ADH1B*3 causes a more rapid metabolism of alcohol. The allele ADH1B*3 is only found in those of African descent and certain Native American tribes. African Americans and Native Americans with this allele have a reduced risk of developing alcoholism. , however, have a significantly higher rate of alcoholism than average; it is unclear why this is the case, but risk factors such as cultural environmental effects e.g. have been proposed to explain the higher rates of compared to alcoholism levels in Europeans. A of more than 100,000 human individuals identified variants of the gene KLB, which encodes the β- , as highly associated with alcohol consumption. The protein β-Klotho is an essential element in s for s involved in modulation of appetites for and alcohol. A GWAS has found differences in the genetics of alcohol consumption and alcohol dependence, although the two are to some degree related. Epidemiology for alcohol use disorders per million inhabitants in 2012. }} (15+), in litres of pure alcohol}} The estimates that as of 2010 there are 208 million people with alcoholism worldwide (4.1% of the population over 15 years of age). Substance use disorders are a major problem facing many countries. "The most common substance of abuse/dependence in patients presenting for treatment is alcohol." In the , the number of 'dependent drinkers' was calculated as over 2.8 million in 2001. About 12% of American adults have had an alcohol dependence problem at some time in their life. In the United States and Western Europe, 10 to 20 percent of men and 5 to 10 percent of women at some point in their lives will meet criteria for alcoholism. had the highest death rate from alcohol in Europe in 2015 at 8.8 per 100,000 population. In the United States, 30% of people admitted to hospital have a problem related to alcohol. Within the medical and scientific communities, there is a broad consensus regarding alcoholism as a disease state. For example, the American Medical Association considers alcohol a drug and states that "drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity)." Alcoholism has a higher prevalence among men, though, in recent decades, the proportion of female alcoholics has increased. Current evidence indicates that in both men and women, alcoholism is 50–60 percent genetically determined, leaving 40–50 percent for environmental influences. Most alcoholics develop alcoholism during adolescence or young adulthood. 31 percent of college students show signs of alcohol abuse, while six percent are dependent on alcohol. Under the 's new definition of alcoholics, that means about 37 percent of college students may meet the criteria. Prognosis }} Alcoholism often reduces a person's life expectancy by around ten years. The most common cause of death in alcoholics is from cardiovascular complications. There is a high rate of in chronic alcoholics, which increases the longer a person drinks. Approximately 3–15 percent of alcoholics commit suicide, and research has found that over 50 percent of all suicides are associated with alcohol or . This is believed to be due to alcohol causing physiological distortion of brain chemistry, as well as social isolation. Suicide is also very common in adolescent alcohol abusers, with 25 percent of suicides in adolescents being related to alcohol abuse. Among those with after one year, some met the criteria for low-risk drinking, even though only 25.5 percent of the group received any treatment, with the breakdown as follows: 25 percent were found to be still dependent, 27.3 percent were in partial remission (some symptoms persist), 11.8 percent asymptomatic drinkers (consumption increases chances of relapse) and 35.9 percent were fully recovered – made up of 17.7 percent low-risk drinkers plus 18.2 percent abstainers. In contrast, however, the results of a long-term (60-year) follow-up of two groups of alcoholic men indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence." There was also "return-to-controlled drinking, as reported in short-term studies, is often a mirage." References Category:Psychology